Hepatomegaly and ascites in a patient with UC

A 29-year-old Chinese man with a 6-year history of UC (Montreal classification E3) had achieved symptom remission 4 years ago after 1 year of treatment with infliximab (5 mg/kg at 0, 2 and 6 weeks, followed by every 8 weeks) combined with azathioprine (50 mg/day). He then self-switched to mesalazine (4 g/day). He returned to our hospital with severe bloody diarrhoea (over 20 bowel movements/day) for 1 week. On admission, he had a mild fever (37.8°C), tachycardia (120 bpm), pallor and pitting oedema in both lower extremities. Laboratory analysis revealed anaemia (7.5 g/dL), hypoalbuminaemia (2.8 g/dL), thrombocytosis (638 k/mm3), leucocytosis (23.71 k/mm3), elevated C reactive protein (112.3 mg/L), elevated erythrocyte sedimentation rate (55 mm/h) and mildly elevated GGT (80 U/L). Viral markers for HIV, HBV and HCV were negative. A colonoscopy revealed severe pancolitis with deep ulcers (figure 1A). Given the consideration of acute …